The primary objective of the patient access core is to maintain our current high volume of acute stroke patients treated with intravenous tissue-plasminogen activator (iv tPA) within 2 hours of onset of symptoms. We have developed an efficient and reliable internal system for the triage and treament of patients with acute ischemic stroke, as well as an extensive community network involving both hospitals and emergency medical systems (EMS) providers. This effort has been a collaborative process involving physicians and nurses from stroke neurology, the emergency department, and radiology, as well as hospital administration and other support staff these departments and the pharmacy. This infrastructure will be utilized to accomplish the objectives of the patient access core. In addition, we have developed a comprehensive stroke patient registry, aspects of which will be integrated into the SPOTRIAS network. The Patient Access Core has 4 major purposes. The first is to ensure that we treat at least 12 patients with iv tPA per year within 2 hours of onset of symptoms. This has been and will continue to be accomplished through continuous quality assurance efforts led by the Emergency Department Acute Stroke Committee, as well as continuing educational outreach efforts to EMS and referring hospitals and physicians. We have strong preliminary data that these efforts are necessary. The second purpose is to identify, recruit and enroll patients for projects 2 and 3. We will train emergency room staff, neurology and emergency department residents to identify patients eligible for these two protocols. SPOTRIAS research coordinators will recruit and enroll patients into these studies. The third purpose is to enroll stroke patients into the Cognitive Rehabilitation and Recovery Group (CRRG) database. This is our comprehensive registry of stroke patients seen at our institution. The database has been a valuable resource for preliminary data for the development of research protocols, including acute stroke intervention, secondary stroke prevention, and rehabilitation studies. In addition it has been used to identify patients eligible for secondary stroke prevention studies and trials of rehabilitation interventions. The fourth purpose is to collect serum and DMA samples (Core E) from patients enrolled in the CRRG for storage and possible further analysis by intramural and extramural SPOTRIAS investigators.